Unit 4 FA2014 - Audio for Students
Transcript of Unit 4 FA2014 - Audio for Students
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Rh Isoimmunization
Mom is Rh-negative
Baby is Rh-positive (antigens are foreign
to moms immune system)
Development of maternal antibodies inresponse to Rh-antigens
Mom is not affected
If sensitization occurscrosses theplacentamay affect the baby (and
subsequent pregnancies)
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Rh Immune Globulin:
Rh Immune globulin (RhIG or Rhogam) is aconcentrated solution of IgG and anti-D derived fromhuman plasma.
Indications
Dosage
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RhoGam Workup
Alternate Name Rh (D) Immune Globulin HumanTest includes:
Mother
Baby
ABO and Rh
Indirect Coombs
ABO and Rh
Direct Coombs
Timing: Specimen collected AFTER delivery.
Testing and administration of RhoGam
should be within 72 hours of delivery
Expected Results: Coombs Negative (< 15 ml fetal RBCs)
Then 300 mcg IM given
What if results are positive:
(> 15 ml fetal RBCs)
Kleihauer-Betke test will be done to
determine the dose of RhoGam to be
administered
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Rhogam Nursing
Interventions Patient teaching
Consent form (if required by agency)
Confirm dose and lot number (bloodproduct)
Observe 20 minutesallergic
response
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Rubella vaccine Rubella non-immune (10-20%)
Titer of 1:8
Enzyme immunoassay level (EIA) less than 0.8
Rubella recommended during PP period
Given SQ O.K. with breastfeeding
Live virus
Caution with members of household who are
immunocompromised
Viral shedding in urine and body fluids
Contraception for 1 month after vaccine (birth
defects)
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PostpartumDiscomfort
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Postpartum Discomfort
#1 Priorityidentify and treat the cause
Afterbirth pains
Episiotomy or lacerations
Hemorrhoids
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Postpartum Discomfort
Nonpharmacologic Interventions
Side lying
Pillow with sitting
Application of ice
Topical (as ordered)
Dry heat
Cleansing with squeeze
bottle, cleansing showeror sitz baths
Witch hazel pads(hemorrhoids)
Pharmacologic Interventions
Opioids Morphine
Percocet
Percodan Nonopioid
Tylenol, Ibuprofen
NSAIDS Naproxen, Anaprox
Topical antiseptic oranesthetic ointmentsand/or sprays
PCA (C-section)
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Psychological assessment
Taking in
Taking hold
Letting go Table 20-4, page 516
Postpartum blues
Postpartum depression Box 21-4, page 547
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Breastfeeding
Commitment
Positioning and latching
Early hunger cues
Late hunger cues
Frequency
Early and often
Increase # of receptor sites
Aids to BF
Pillows, nipple shields, breast cream
Breast pumps
Bras and clothing
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Breast milk Storage
Containers
Temperature
Refrigerator vs. Freezer Patient Teaching, page 650
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Breastfeeding
Contraindications Infants with galactosemia
Active, untreated TB in mother
Maternal HIV
Maternal human T-cell lymphotropic virus type I or IIpositive
Moms who are receiving diagnostic or therapeutic
radioactive isotopes pump and dump (for as long as
there is radioactivity in the milk) Moms with herpes lesions on the breast
Moms receiving chemotherapy
Moms who are abusing street drugs
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Medications & Breastfeeding
Lactation Risk Categories
L1safest
L2safer
L3moderately safe
L4potentially hazardous
L5 - contraindicated
FDA Categories
A
B
C
D
X
Table 21-1, page 547Antidepressant Medications
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Bottlefeeding
Equipment
Bottles, nipples, sterilizing equipment
Type of formula
Regular, soy, special-needs
Heating sources
Suppression of lactation
Ace wrap/tight fitting bra
Cold packs
NSAIDS
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Postpartum Discharge
Before 24 hours
Shortens hospital stay for low risk births
Reduces health care costs
Less medical intervention and more family-focusedexperience
Newborns and Mothers Health Protection Act of 1996
48 hours 96 hours
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Patient Teaching
Signs/Symptomscall MD/CNM
Fever
Breasts
Bleeding
Pain
Edema
Neurologic
Emotional
Elimination
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End of Content for Exam II